Abstract:
Currently available therapeutic modalities for alcohol use disorder (AUD) produce limited effect sizes or long-term compliance. Recent methods that were developed to modulate brain activity represent potential novel treatment options. Various methods of brain stimulation, when applied repeatedly, can induce long-term neurobiological, behavioral, and cognitive modifications. Recent studies in alcoholic subjects indicate the potential of brain stimulation methods to reduce alcohol craving, consumption, and relapse. Specifically, deep brain stimulation (DBS) of the nucleus accumbens or non-surgical stimulation of the dorsolateral prefrontal cortex (PFC) or medial PFC and anterior cingulate cortex using transcranial magnetic stimulation (TMS) has shown clinical benefit. However, further preclinical and clinical research is needed to establish understanding of mechanisms and the treatment protocols of brain stimulation for AUD. While efforts to design comparable apparatus in rodents continue, preclinical studies can be used to examine targets for DBS protocols, or to administer temporal patterns of pulsus similar to those used for TMS, to more superficial targets through implanted electrodes. The clinical field will benefit from studies with larger sample sizes, higher numbers of stimulation sessions, maintenance sessions, and long follow-up periods. The effect of symptoms provocation before and during stimulation should be further studied. Larger studies may have the power to explore predictive factors for the clinical outcome and thereby to optimize patient selection and eventually even develop personalization of the stimulation parameters.
摘要:
目前可用的酒精使用障碍(AUD)的治疗方式产生有限的效果大小或长期依从性。最近开发的调节大脑活动的方法代表了潜在的新治疗选择。各种脑刺激方法,当反复应用时,可以诱导长期的神经生物学,行为,和认知修改。最近对酒精受试者的研究表明,大脑刺激方法可以减少对酒精的渴望,消费,和复发。具体来说,使用经颅磁刺激(TMS)对伏隔核进行深部脑刺激(DBS)或对背外侧前额叶皮质(PFC)或内侧PFC和前扣带回皮质进行非手术刺激已显示出临床益处。然而,需要进一步的临床前和临床研究来了解脑刺激治疗AUD的机制和治疗方案.虽然在啮齿动物中设计可比设备的努力仍在继续,临床前研究可用于检查DBS方案的目标,或者管理类似于TMS的脉冲时间模式,通过植入电极到达更表面的目标。临床领域将受益于更大样本量的研究,更多的刺激会话,维护会议,和长期的随访期。应进一步研究刺激之前和期间症状激发的效果。较大的研究可能有能力探索临床结果的预测因素,从而优化患者选择,最终甚至开发刺激参数的个性化。